NeuroVoices: Valentina Popova, MD, on Pediatric Migraine Awareness and Management

Valentina Popova, MD

June is National Headache and Migraine Awareness Month (MHAM), a global social initiative to raise awareness about migraine and other headache diseases. Migraine, defined as an acute recurrent headache, occurs in about 3% of children of preschool age, 4% to 11% of elementary school-aged children, and 8% to 15% of high school-aged children.

In early childhood and before puberty, migraine is more commonly observed in boys than girls, though in adolescence it more commonly affects young women. Migraine has several symptoms and triggers that vary on an individual level. Additionally, some 60% to 70% of people who have migraine headaches also have an immediate family member who have or may have had a migraine.

Despite documented evidence of the effects of migraine on the pediatric population, public perception tends to naturally associate the disease with adults. Valentina Popova, MD, expressed concerns about the lasting inconsistencies with awareness among parents, pediatricians, and children on the impact migraine can have at a young age. Popova, a pediatric headache specialist at NYU Langone, sat down with NeurologyLive for this iteration of NeuroVoices to discuss how pediatric migraine is managed, where the issues of awareness stem from, and the signs and symptoms parents should look out for in their kids.

NeurologyLive: What are the signs and symptoms for children with migraine?

Valentina Popova, MD: Signs and symptoms of migraine in kids can be a little different than adults. Children just like adults can say their head hurts or that they have pain. They may hold a part of their head, whether that be the back or the side. Their headaches may be associated with nausea or vomiting. They say that their belly hurts. Some kids may not be able to articulate what nausea is necessarily. They may say they feel off, they’re not hungry, or they don’t want to eat. Obviously, they can have vomiting and symptoms of light and sound sensitivity. Parents can infer from their behavior if they don’t want to watch TV, don’t want to be outside in the sun, or if they go into their bedroom or a dark room and rest. Sometimes those things that kids will do can give you an idea.

Is the level of awareness for pediatric migraine where it should be among children and their parents?

It’s a combination. The awareness is definitely increasing. The American Migraine Foundation is doing lots to educate people about migraine, and that it can affect all ages, and in kids as well. Sometimes if parents have migraine, they can identify those signs in their own kids. They may say, “well, this is probably it.” Migraine can skip generations, so for parents who don’t have it, they may be more concerned about what’s going on with their kids. There definitely needs to be more education on when to see a migraine specialist or headache specialist, as well as when there needs to be more work done. It’s important to educate parents and schools because that’s a large part of the people that interact with kids and where their migraines can be present.

Are pediatricians aware of the signs and symptoms of pediatric migraine?

Yes and no. Headache is one of the most common symptoms that kids can come to pediatricians or neurologists for. At the beginning, they can educate kids on the lifestyle and things like that. As things can become more problematic and more frequent, some, not all, pediatricians are aware of different prevention mechanisms and treatment mechanisms. It all depends. It can vary if they work in a larger center like a big hospital or a smaller practice. It’s important to reach out to those people and the pediatricians to educate them about it as well.

How is migraine currently managed among children and adolescents?

The first thing I always start talking about with my patients and families is lifestyle. Again, migraine is a genetic diagnosis. It is something that most people will have to deal with if they are diagnosed with it at some point throughout their lives. It can be in different capacities, but it can be there. It’s important to teach kids at a young age about that lifestyle and how maintaining a regular healthy schedule is key to migraine prevention and management. Setting those patterns and skills for them as early as possible is extremely important.

At every visit with all my patients, I go over the importance of regular lifestyle. That includes things like regular exercise and getting regular sleep. Making sure that they’re going to bed at around the same time and waking up around the same time. The amount of sleep kids need changes based on their age, so it’s important to address it. Eating breakfast in the morning with some protein is important to try to prevent migraines throughout the day. Hydrating and drinking an adequate amount of water is important as well. For an adult, it’s about 8 to 10 cups a day, but in kids it depends on how big they are. We talk to the kids and parents to individualize this.

I advise to limit things like caffeine. There can be this big misconception that caffeine can treat migraines. It’s important to counsel patients on this so that they don’t get into a bad habit or cycle. Aside from lifestyle, we talk about the ways you can treat migraine. This includes ways to prevent headache, as well as what you do when you have a headache. Depending on the age and severity of the headache in the child, we talk about what medicine they can take when they geta migraine. Some of these can be over the counter, and others may be prescription. We talk about this with the parents because the other part of managing migraines appropriately is treating them appropriately. It’s important to have a plan on what the child should do if they’re starting to feel symptoms of a headache.

Transcript edited for clarity.

REFERENCE

Migraines in Children and Adolescents. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/9637-migraines-in-children-and-adolescents. Accessed June 29, 2021.